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Nicotine Lozenges Nicotine lozenges Please note: This information is not intended to replace the Consumer Medicine Information (pack insert) that may come with the nicotine lozenge. If you do not have a pack insert, ask your pharmacist for it, or for advice if one is not available. Main points about nicotine replacement therapy products • All forms of nicotine replacement therapy (NRT) products – patches, lozenges, mouth spray, gum and inhalator – have been proven to help people quit smoking.1 • Using NRT products is always safer than continuing to smoke.2 NRT products are a safe alternative to cigarettes for smokers.3 • Using NRT products will still increase your chances of quitting even if it does not completely control cravings.4 • NRT products reduce the severity of cravings but you may still have them, especially in situations in which you are used to smoking.5-7 • Using the patch plus another NRT product (combination therapy) increases your chance of stopping smoking compared to just using one NRT product, and is better at suppressing cravings.8, 9 • NRT product work better when you also reduce triggers for cravings. Boost your chance of success by making your home smokefree and, if possible, get rid of all cigarettes in your home and car.10, 11 You will also need to find new habits to take the place of smoking; for example, when you’re stressed, socialising, concentrating, filling in time or when drinking alcohol or coffee. • Research shows that people who have the best chance of stopping smoking using NRT products also get advice or support from their doctor, pharmacist or other trained advisor (such as through the Quitline).1, 12, 13 • If you slip-up and have a cigarette, it is safe to continue using NRT products and to keep trying to quit.14 • It is common for smokers to attempt to quit a number of times before they successfully stop.15 09/19 2 Is the nicotine lozenge suitable for me? The nicotine lozenge works best for addicted smokers who want to quit.1 Your doctor or pharmacist can advise you whether the nicotine lozenge is suitable for you. Signs of addiction include: • You smoke your first cigarette within 30 minutes of waking up.12, 16 • You smoke more than 10 cigarettes per day.12, 16 (There is no difference between smoking stronger or weaker tasting cigarettes.17) • You suffer from withdrawal symptoms within 24 hours of stopping smoking, such as cravings, irritability, anxiety, depression, restlessness, hunger, poor concentration or sleep disturbances.12, 18 It is not known whether smokers of 10 or less cigarettes per day would benefit from using the nicotine lozenge, but counselling and use of self-help materials is encouraged.1, 12, 15 If you are age 12 years and over, you may use the nicotine lozenge. However, if you are under 18 years you should speak to your doctor before using the lozenge. People in this age group need to discuss stopping smoking with a trained health advisor to get any benefit from using nicotine lozenge.12, 15, 19, 20 How does the nicotine lozenge work? Addiction to nicotine in tobacco is the main reason why people continue to smoke. The lozenge works by replacing some of the nicotine you would normally inhale from cigarettes.21 It is a tablet that dissolves in your mouth. It slowly releases nicotine, which you absorb through the lining of your mouth.6, 19 Using the lozenge can help to reduce withdrawal symptoms when you quit, such as cravings, difficulty concentrating, frustration, restlessness, and anxiety.22-24 The higher dose reduces more of these symptoms than the lower dose.23 However, it may not stop these symptoms completely.6 More options are listed below under ‘Why may I still have cravings while using the lozenge?’ Buying the lozenge You can buy nicotine lozenges without prescription from pharmacies, some supermarkets and online. You can also buy the lozenges with a prescription from your doctor through the Pharmaceutical Benefit Scheme (PBS), which is cheaper. 3 There are two strengths of lozenge, 2 mg and 4 mg, and two strengths of mini lozenge (also called ‘Minis’®), 1.5 mg and 4 mg. They come in pack sizes ranging from 20 to 80 lozenges, and 20 or 60 mini lozenges. If you buy them over-the-counter, it costs around $17 for a pack of 20 lozenges and $52 for a pack of 80 lozenges (based on recommended retail prices as at March 2019). Mini lozenges cost about $19 for a pack of 20 and $50 for a pack of 60. Store prices can be a few dollars higher or lower. The 4 mg and 2 mg lozenges are listed on the PBS, but the mini lozenges are not. You can buy one 12 week course of either the nicotine patches, lozenges or gum through the PBS per year.25 To get the prescription, you must take part in a quit smoking support program, such as that provided by the Quitline. Your doctor will give you a prescription that will last four weeks on your first visit, and then, on your second visit, two repeat prescriptions for a further eight weeks of lozenges. Remember to book your second appointment with your doctor before your first prescription runs out. In 2019, general patients pay $40.30 (PBS price) for each 4 week prescription (216 lozenges) and concession holders pay $6.50.26 How well does the lozenge work? People who use the nicotine lozenge are more likely to quit and stay stopped.1 The 4 mg nicotine lozenge appears to reduce weight gain that may occur after quitting, but doesn’t have a lasting effect beyond its use.22 When using the lozenge, you take in less nicotine at a much slower rate than when smoking. This makes it less addictive and easier to stop using than cigarettes, but it is slower at easing cravings than a cigarette. 1, 3, 21, 27, 28 The lozenge dissolves within 16 to 30 minutes and most people find that it starts to ease cravings after about five minutes.19, 29 The mini lozenge dissolves faster (10 to 13 minutes) than the lozenge. Over a day, mini lozenge users typically absorb more nicotine than from a similar strength nicotine gum.20 Which strength of lozenge should I use? Your pharmacist or doctor can advise you which lozenge strength is suitable for you. The 4 mg lozenge or mini lozenge is recommended for more dependent smokers: that is, if you usually have your first cigarette of the day within 30 minutes of waking up, or you smoke more than 20 cigarettes per day.19, 20 The 2 mg lozenge or 1.5 mg mini lozenge is recommended for less dependent smokers: if you usually smoke your first cigarettes more than 30 minutes after you wake up, or you smoke 20 cigarettes or less per day.19, 20 4 What do I need to tell my pharmacist or doctor? Before buying the lozenge, you should tell your pharmacist or doctor if you have an illness, or if you are taking any other medicines (even non-prescription ones). In some cases, you may need medical supervision or advice, or in other cases the nicotine lozenge may not be suitable. Please check the Consumer Medicine Information (pack insert) that comes with the lozenge, or with your pharmacist, for the latest list of common medicines and medical conditions that may be affected by using the lozenge or stopping smoking. Illnesses for which you may need medical advice include: heart disease, stroke, high blood pressure, any blood circulation disorder, epilepsy or seizures, gastric problems (food pipe and stomach), kidney disease, liver disease, overactive thyroid gland, diabetes, phaeochromocytoma (a tumour of the adrenal gland) and any allergic reaction that involves swelling of the lips, face and throat or itchy skin rash.19, 20 Can I use the lozenge if I am pregnant or breastfeeding? If you are pregnant or breastfeeding, it is recommended that you first try to quit without medication.12 Your Quitline counsellor can offer you practical advice and support, no matter where you’re at with your smoking. If you are unable to quit without medication, you may use the lozenge or mini lozenge to help you quit.12 You need to discuss the risks and benefits with your pharmacist or doctor before using it, and you should tell the doctor supervising your pregnancy.30, 31 While using the lozenge is considered safer than smoking, even this smaller amount of nicotine may not be entirely risk-free for your baby.30 Mothers using the lozenge should breastfeed their baby first, then use the lozenge soon after. This allows time for the nicotine in their breastmilk to decrease before the next feed.19, 20, 32 If you have any questions regarding these issues, please ask your doctor. Using the lozenge A problem to avoid You should avoid eating and drinking 15 minutes before, and during, use of the lozenge (except for water). Acidic foods or drinks, such as orange juice, coffee, beer and soft drink, interfere with the amount of nicotine passing through the lining of your mouth from the lozenge.19 5 Using the lozenge Once you’ve bought the lozenges, it can help to set a quit date.33 Place a lozenge in your mouth and let it dissolve. This should take about 16 to 30 minutes for the lozenge and 10 to 13 minutes for the mini lozenge.19, 20, 29 Move the lozenge about in your mouth from time to time. Do not chew or swallow the lozenge.
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